Collier nonprofit may seek role in state health reform

Bruce Sherman, left, the grant committee chairman for the Naples Children & Education Foundation, applauds Richard Akin, the C.E.O. of Collier Health Services and Cathy Jenkins from the University of Florida Dental College, as they accept a ceremonial check for $5.85 million on Tuesday at The Ritz-Carlton Tiburon in North Naples. The money will go toward the Pediatric Dental Health Center that is being developed at the Edison College Collier County Campus. The grant was part of reserve money set aside for long-term projects and not part of the 2007 Winter Wine Festival money. Lexey Swall/Staff

A Collier County-based nonprofit entity under contract already with the state to be a Medicaid managed-care provider may play a role in a state insurance exchange for consumers under federal health care reform.

"We are exploring that right now, we are interested," Richard Akin, chairman of Integral Quality Care, said. "I can't say 'yes' we are going to do it (or not). We see a great possibility for Integral Health Care to be active in that arena."

Integral was formed in 2010 as a separate nonprofit company under Collier Health Services, a longtime clinic operator, to offer Medicaid managed care networks in communities. Today, Integral operates in seven Florida counties, including Collier.

Some administrators with Integral, which has its operations in Tampa, are looking at what makes sense for Integral as a potential insurance provider through a state insurance exchange. But Akin said no date has been set for staff members to present their findings.

An insurance exchange is a key part of the Affordable Care Act, the 2010 law passed under President Obama, which was upheld by the U.S. Supreme Court in June and remains on course for a full rollout following Obama's re-election last week.

Gov. Rick Scott was fighting the reform measures and opposed setting up a state exchange where Floridians would be able to shop and buy insurance in 2014 or pay a penalty if they don't. Low income residents would be eligible for subsidies to help defray the expense.

Scott is now stepping back from his previous stance and faces a Friday deadline, like all other states, to let the federal government know how the state intends to proceed. That could be establishing a state-run exchange, partnering with another state or allowing the federal government to set up the exchange in Florida. Scott said earlier this week to state media that he is willing to "have a conversation" about the issue.

In Florida, 3.8 million residents are uninsured, or 20 percent of the state's population, according to the Kaiser Family Foundation, a leading health policy group based in Washington, D.C. Many residents would gain coverage through an exchange or through a $2-billion expansion of Medicaid, another component of the Affordable Care Act. Scott also has said Florida would reject the federal money to expand Medicaid.

The governor's office was unavailable for comment Wednesday about how the state intends to respond to Friday's deadline with the federal government.

One of the state's largest commercial insurers, United Healthcare, confirmed it is still exploring how to proceed.

"We believe exchanges have the potential to be a valuable additional tool to provide access to coverage for consumers while enhancing consumer choice and innovation," United Healthcare said in a statement. "Given the regulatory variation from state to state, and many states have not yet formalized their exchange models, we have not yet made any decisions about where we will be offering our health plans through the exchanges."

Officials at the publicly run Lee Memorial Health System in Lee County are finding the uncertainty of how the state will move forward makes it difficult to plan for the future, said Lee Memorial spokeswoman Mary Briggs.

"Clearly we do want everyone in Florida to have insurance, that's what is best for Florida families," Briggs said.

If the state does not go forward with expanding Medicaid or setting up the insurance exchange, the outcome could be serious in Florida, especially in Southwest Florida where 30 percent of the population is uninsured, said Jim Nathan, president and chief executive officer of Lee Memorial.

"Absent participation, Florida policymakers will be faced with the challenge of figuring out the best way to deliver appropriate health service for the poor and uninsured. Presently, a massive hidden tax is being imposed on employers and individuals who purchase health insurance," Nathan wrote in an upcoming weekly column. "This is destroying commercial insurance."

Akin, who is chairman of the Lee Memorial board but does not share information about Integral with the board, said Integral would not be ready to submit anything to the governor's office Friday about interest in a potential state exchange. Part of the hardship has been the wait for federal guidelines for how the exchanges can be set up.

"It may turn out it may be something right up our alley or it may be something we can't do," Akin said.